Healthcare Provider Details

I. General information

NPI: 1881080752
Provider Name (Legal Business Name): AVENIR MEDICAL SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2015
Last Update Date: 04/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 THACHER LN
SOUTH ORANGE NJ
07079-2463
US

IV. Provider business mailing address

102 THACHER LN
SOUTH ORANGE NJ
07079-2463
US

V. Phone/Fax

Practice location:
  • Phone: 973-580-1372
  • Fax:
Mailing address:
  • Phone: 973-580-1372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMAL ANDREW REVOLUS
Title or Position: OWNER
Credential:
Phone: 973-580-1372